Chronic venous insufficiency

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: BD74.Z

Chronic venous insufficiency, chronic venous insufficiency, CVI, varicose veins, varicosis.

Edema formation, and irreversible change in the veins, surrounding tissues and muscle fascia due to chronic. Reflux of venous blood.

  • Women > men
  • Prevalence: 15-50% affected depending on source

Division according to Widmer

 Clinic

Stage I

 Edema, corona phlebectica paraplantaris

Stage II

Stage I &

  • Purpura jaune d'ocre (stage IIa)
  • Hypodermitis & dermatolipofasciosclerosis stage IIb)

Stage III

Stage I + II &

  • Scars after healing of a venous ulcer

Stage IIIa

Stage I + II &

  • Ulcus cruris venosum

Classification according to CEAP (clinical, etiologic, anatomical, pathophysiological)
degree Expression
C0 No visible signs
C1 Besense veins, telangiectasias or reticular veins
C2 Varices
C3 Varicosis with oedema
C4

Varicosis with trophic skin lesions

  • Pigmentation
  • Stasis dermatitis
  • Lipodermatosclerosis
C5 C4 + healed ulcer
C6 C4 + florid ulcer

  • Insufficiency of superficial, deep or transfascial veins
  • Emergence is possible in the setting of:
    • Primary varicoses
    • Secondary varicoses
    • Phlebothrombosis
    • A post-thrombotic syndrome

  • The examination should always be performed standing up due to the hydrostatic pressure.
  • Purpura jaune d'ocre: Due to increased hydrostatic pressure, erythrocyte extravasation occurs with consequent haemosiderin deposition, leading to hyperpigmentation on the lower legs.
  • Hypodermatitis: Aseptic, acute inflammation of the cutaneous subcutaneous tissue. This is often painful and occurs with redness and tension (pseudoerysipelas). In the course, transition into dermatoliposclerosis.
  • Dermatoliposclerosis: proteins leaking in the context of hydrostatic pressure lead to increased cutaneous and subcutaneous collagen synthesis and fibroblast stimulation.
  • Atrophy blanche/ capillaritis alba: Porcelain-coloured scarring healing skin atrophy around the ankles or around an ulcer. There is an increased risk of ulceration.

  • Clinic
  • Phlebological examination

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